What Is Prolotherapy? How Is It Applied To Whom?

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What Is Prolotherapy?

Prolotherapy is an injection technique that involves injecting various regenerative, proliferative, or irritant solutions into the joint or into the tendon attachment areas around the joint for the purpose of treatment in musculoskeletal injuries, joint wear, muscle pain, and joint and ligament laxity. It is not a surgical treatment. It is also known as regenerative joint injection or non-surgical ligament and tendon reconstruction.

How Does Prolotherapy Work?

Whether acute or chronic, the healing process of injured or damaged tissues involves inflammation. Inflammation is necessary for our bodies to repair themselves after a new injury.

However, in chronic diseases, inflammation can become constant and destructive. Prolotherapy aims to initiate a controlled, limited inflammation and healing process in damaged tissue.

This injection initiates a sterile inflammation process in the body and triggers the body’s natural healing and regeneration process. In other words, a controlled injury is created in that area. During the healing of this injury, the damage or chronic problems in that area are also repaired.

In prolotherapy, the entire damaged tissue is targeted. The aim is to reduce pain and restore lost functions by healing the tissue. However, it is important that this injection is performed with the correct technique and applied to the right place.


The most commonly used proliferative substance today is dextrose. In addition to dextrose, PRP, stem cells, medical ozone, and glycerin can also be used as proliferative substances. These substances initiate the body’s own self-healing response when injected.

Glucose blocks pain transmission at the cellular level at low concentrations, while it has a proliferative effect at high concentrations. When given into the joint, it has a regenerative effect on cartilage cells.

It is used to treat joints and tendons. The most common areas where it is used are the joints and ligaments of the spine, neck, back, knee, hip, shoulder, elbow, wrist, and ankle.

It was first introduced by Dr. George Stuart Hackett in the 1930s. Dr. Hackett published a book on this subject in 1956. Many prolotherapy practitioners still benefit from this book today.

Who iIs Prolotherapy Applied To?

  • Knee diseases: knee arthritis, ligament tears, meniscus tears, chondromalacia, tendon strains, muscle strains etc.
  • Neck region diseases: headaches, cervical disc herniation, facet syndrome, arthrosis/calcification etc.
  • Pain in the jaw joint
  • Hernia in the back, facet syndrome, painful costal syndrome
  • Disc diseases in the lumbar region, instability, calcification, postoperative pain, iliolumbar syndrome, etc.
  • Sacroiliac joint instability and pain
  • Ligament tears/damage in the shoulder, shoulder dislocations, shoulder impingement syndrome, rotator cuff injuries, shoulder joint calcification, shoulder capsule injury/tear
  • Elbow pain, arthritis, tennis elbow, golfer’s elbow, ligament and tendon tears
  • Pain in the wrist and at home, calcification, nerve compression, carpal tunnel syndrome, ligament tears
  • Pain in the hip region, pain originating from the muscles and tendons of the hip, calcification in the hip
  • Ankle and foot pain, post-sprain injuries, Achilles tendonitis, heel spurs, foot bone and ligament injuries

Who Cannot Do Prolotherapy?

  • Infection in the injection site
  • Bleeding tendency, use of blood thinners
  • Allergic reaction to the materials to be used in injection
  • A systemic infection in the body
  • Suspicion of cancer spread at the injection site
  • Acute period of inflammatory rheumatic diseases other than arthritis
  • Severe infection in the joint septic arthritis
  • Acute period of fracture
  • Untreated dislocations
  • Patients with progressive neurological deficit and urinary incontinence
  • Compliance with treatment, i.e. patient
  • Patient requiring narcotic painkillers for a prolonged period during treatment
  • Epileptic patient without adequate control despite treatment

What Are The Side Effects And Complications Of Prolotherapy?

  • Pain, bleeding, ochymosis and haematoma formation at the injection site
  • Increase in the patient’s current pain
  • Flu-like symptoms
  • Infection, abscess formation at the injection site (1/1000 and 1/10000 procedures)
  • Seizure after injection
  • Allergic reactions
  • Fainting, drop in blood pressure
  • Joint swelling
  • Hardness and swelling under the skin
  • Tendon and ligament rupture/injury
  • Nerve damage and related complications
  • Intravenous injections occur
  • Pneumothorax
  • Headaches

How Many Sessions Of Treatment Is Required In Prolotherapy And How Long Are The Session Intervals?

Generally, six sessions are applied. The ideal session interval is 3 weeks, but more frequent and longer intervals can be applied. The number and frequency of sessions can be planned from patient to patient.

What Should Be The Expectation Of effectiveness In Prolotherapy?

With the treatment, it is expected that our patients will improve functionally, that is, they will be able to do their jobs that they could not do before and their pain will decrease. The strengthening of the ligaments and tendons in that area, the strengthening of the muscles, the reduction of pain, stiffness and stiffness determine the effectiveness of the treatment.

The prolotherapy patient may have an increase in pain 1-2 days after the treatment session. Therefore, it is important that the patient can tolerate the pain in this injection. Because the use of painkillers is not recommended for the pain that occurs after the injection. During the treatment process, the patient’s compliance with the treatment affects the success. The patient should do the exercises regularly, give up his/her wrong habits, change his/her dietary habits and improve his/her lifestyle.

It is important that the patient is awake and feels the pain during prolotherapy. During the application, the patient should be awake and aware of the application. The patient should give feedback to make sure that the injection is made in the right place.

Is Prolotherapy A Treatment Like Cortisone?

No, there are many differences between prolotherapy and cortisone. When cortisone is injected into the joint, it suppresses and masks pain. Cortisone treatment is successful in many patients. Many patients who seek prolotherapy treatment have previously been treated with cortisone, but are no longer responding to cortisone treatment. Studies have shown that cortisone treatment leads to progression of cartilage damage and osteoarthritis in the long term.

Even though pain improves in the short term in patients who have previously had a cortisone injection, chronic pain can also worsen over the years. Prolotherapy is a regenerative injection therapy that repairs damaged tissues and weakened ligaments and tendons.

Prolotherapy is considered an alternative treatment to surgery and other pain treatments such as cortisone. During this treatment, patients are active and working, and it is a very safe treatment.

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